口腔颌面外科患者术后过早拔除气管插管可能发生危险,其危险性和延迟保留插管所产生的并发症必须加以权衡。拔管应结合主客观指标来决定。本文对拔管时应考虑的因素进行讨论。插管并发症:下列因素之一可导致插管阻塞:1)分泌物、血液、插管内异物;2)插管扭结;3)气囊的过度压迫使管壁向内塌陷;4)气囊滑至管口并将其堵塞;5)气囊充气不对称使插管贴附于气管壁。气管插管48小时或更长一些时间内主要的并发症是气管粘膜损伤,进而发展为软骨环破坏、气管腔周围痂皮形成和气管狭窄。还可发生水肿、感染、脱痂皮和溃疡。延迟拔管引起的喉溃疡可伴有肉芽肿形成。喉溃疡最常见于声带后缘的杓状软骨粘膜,初发的溃疡最可能由插管造成的损伤所致,头部过度活动和由于局麻不充分使反射仍然存在可加重损伤,术前呼吸道感染也加重喉反应,有1/3的患者可发生杓状软骨肉芽肿,但多数可恢 Oral and maxillofacial surgery premature removal of the tracheal intubation may be dangerous, the risk and delay to retain the complications caused by intubation must be weighed. Extubation should be combined with subjective and objective indicators to decide. This article discusses the factors that should be considered when extubation. Intubation complications: One of the following factors can lead to obstruction of the intubation: 1) secretions, blood, intratracheal foreign bodies; 2) cannula kink; 3) excessive compression of the balloon to collapse the wall inward; 4) To the nozzle and plug it; 5) inflatable balloon asymmetry intubation attached to the tracheal wall. Tracheal intubation for 48 hours or longer the main complications of tracheal mucosal injury, further development of the destruction of the cartilage ring, the tracheal lumen around the formation of the scab and tracheal stenosis. Edema, infection, scab off and ulcers can also occur. Delayed extubation caused by throat ulcers may be associated with granuloma formation. Laryngeal ulcer is most common in the arytenoid cartilage mucosa of the vocal cord posterior margin, the initial ulcer most likely caused by intubation injury, excessive head activity and reflex due to insufficient local anesthesia can aggravate the injury, preoperative respiratory tract Infection also aggravates the laryngeal response, and 1 in 3 patients develops arytenoid cartilage granuloma, but most can recover